Provider Demographics
NPI:1427101443
Name:ANTERASIAN, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ANTERASIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 PRADO DE LAS CABRAS
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3627
Mailing Address - Country:US
Mailing Address - Phone:818-667-2720
Mailing Address - Fax:310-829-3809
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-829-9289
Practice Address - Fax:310-829-3809
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47175207N00000X, 207NS0135X, 207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92706Medicare UPIN